A failure to protect

Background checks designed to identify dangerous new residents of Illinois nursing homes often fall short by missing ex-convicts' violent crimes and downplaying the risks they pose to others, the Tribune has found.

Some of these offenders went on to commit assaults and other serious crimes inside the homes where they lived.

With growing numbers of mentally ill felons entering Illinois nursing homes, the state in 2006 became the first to require criminal background checks as part of an overall risk assessment of new residents. The screenings by state contractors are used to identify high-risk individuals who should live in private rooms and be closely monitored.

But a review of confidential reports in 45 recent cases shows that in many instances the assessments were incomplete, leaving out some criminal convictions and other crucial details.

In addition, although Illinois requires ex-convicts to be screened within days of admission to a nursing home, many of the assessments obtained by the Tribune were completed months after the offenders moved in -- and some more than a year later.

Of the 3,000 felons living in Illinois nursing homes as of June, less than 1 percent were classified as "high risk," which requires the facilities to place them in single rooms near nurses' stations, according to the state health department.

Two-thirds -- a total of 2,077 felons -- were classified as "low risk," meaning the nursing homes are to treat them no differently than residents without criminal records. The rest were designated "moderate risk." These residents are to be watched more closely, but no other security precautions are required.

Typical of the incomplete assessments was the May 2008 report on John Pittman, 45. The state's evaluation acknowledged many of his convictions for drug trafficking, violating restraining orders and domestic battery but cleared Pittman as a moderate risk, noting that staffers at Evanston's Greenwood Care nursing home "do not view him as a threat for future violence."

The screening report failed to mention that a year earlier in a sister facility, Pittman allegedly had stabbed a resident named Troy Warfield in the face with an ice pick -- or that the victim was also now living at Greenwood Care.

Just before dawn on May 14, 2008 -- the morning after Pittman's screening report was completed -- police say he struck again, slashing the same man with a box cutter.

Long rap sheetsNursing home operators interviewed by the Tribune defended the background checks as adequate and described most felons in the homes as elderly and infirm people convicted of relatively minor offenses decades ago.

Yet the 45 recent state reports examined by the Tribune show only two ex-convicts older than 65; most were far younger. Some had prison stints for crimes ranging from aggravated battery and armed robbery to arson and narcotics use. The felons typically were admitted to nursing homes because they suffer from severe mental illnesses, the records show.

Consider the cases of two offenders recently admitted to Somerset Place, a home with about 400 beds in Chicago's Uptown neighborhood. The facility housed 62 felons in June, state records show.

Clifton Pickett, 34, in May was termed a moderate risk; the assessment noted his convictions for theft and several drug-related offenses.

But separate court and prison records, easily gathered by the Tribune, show the evaluation failed to catch that Pickett had been arrested 30 times since 1992 and convicted for gun possession, burglary and the mugging of a 79-year-old Chicago man. The assessment also did not mention that Pickett had been arrested on three crack cocaine-related charges during previous stays at Somerset in 2006, 2007 and 2008.

Lola Thomas, 47, was admitted to Somerset in November 2008 but not screened for six months, despite a rap sheet showing at least 70 arrests and 19 convictions for crimes including battery, prostitution and narcotics possession.

By the time her assessment was completed, in May, Thomas had hit one resident in the head, threatened others and "been suspected of drug use," her risk assessment report said. She, too, was deemed a moderate risk.

In a statement, Somerset said it works to "maintain a safe environment while providing an opportunity for these residents to improve their lives."

Similar cases cropped up at other nursing homes.

In 2006, for example, 53-year-old Jack Dudley was paroled after a 24-year prison stint for a string of crimes including attempted murder, armed robbery and aggravated battery, according to prison records. Dudley was admitted to Bryn Mawr Care in Chicago's Edgewater neighborhood in 2007 but not screened until 16 months later, in January 2009. Dudley's report rated him a low risk, saying he had been "drug free" and not aggressive since his admission to the facility. Four months after that report, police charged him with marijuana possession and battery after he struck a clerk at a nearby 7-Eleven. A Bryn Mawr spokesman declined comment.

Efforts to reach Pickett, Thomas and Dudley were unsuccessful.

Administrators from nursing homes, who are interviewed as part of the risk assessments, say their top priority is protecting patients. But Brigit Dyer-Reynolds, regional ombudsman at ICARE-Project Advocate, a senior citizen advocacy group in Springfield, suspects some of them may have a financial incentive to downplay an ex-convict's risk to other residents because the added monitoring requires more staffing, services and costs.

"I believe that some people classified as medium- and low-risk should have been classified as high-risk and monitored more closely, but they were not," said Dyer-Reynolds, who said she has reviewed dozens of reports since the screening program began.

A matter of trustMary Driscoll, chief of the state health department's division of patient safety and quality, said she could not comment on individual screenings because of medical privacy laws. But Driscoll defended the assessments, conducted primarily by contractors under deals worth close to a combined $1 million a year, while acknowledging that state officials have never spot-checked them for accuracy.

"We have to trust these people," she said of the contractors. "If the facility is not able ... to protect the loved ones, that's when we go in."

Nursing homes typically do their own screening of potential new residents by reviewing medical and psychiatric reports. But under the 2006 state law, the homes also must conduct a criminal background check on each incoming resident.

If the facility finds a person has been convicted of one of 65 felonies, public health authorities are notified and the state turns the case over to one of its contractors, VIP Security & Detective Services, for a more complete evaluation.

VIP, of Evergreen Park, secured its initial no-bid "emergency" contract to do that job in 2006 despite the fact that its state incorporation papers had lapsed and it had only two employees and reported revenue of just $50,000. Roxanne Jackson, the firm's spokeswoman, attorney and former director, was a $100,000-a-year deputy director of the state health department until October 2004. Her brother owns the firm.

For each prospective nursing home resident, VIP reviews a state police rap sheet supplied by the state health department. But Jackson said the firm is not required under its contract to verify the state police records or search for additional information through courthouses and police departments. "Absolutely not. No, no, no," she said.

VIP said it also relies on face-to-face interviews with the felons as well as nursing home administrators.

"How do you know that somebody is telling you the truth? You don't know," Jackson said. "You hope and you pray."

The packets of information VIP compiles are sent to Belleville forensic psychologist Daniel Cuneo, who with colleagues determines the risk level for each felon. Cuneo also formerly worked for the state health department as clinical director for the state-run Chester Mental Health Center until 2001. "I go on the grounds that anything can be inaccurate, but that's the best information I have at the time," Cuneo told the Tribune.

He compared the criminal history to clues in the TV game show "Wheel of Fortune."

"It's a lot easier to get the word when all the letters are there," Cuneo said. "But in the real world, you don't always get all the letters."

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